A influência de bactérias patogênicas na transportabilidade do escarro e na qualidade de vida de portadores de bronquiectasia

Abstract

Introdução: A qualidade de vida pode estar relacionada com o estado clínico do paciente, com o nível de infecção e com o microorganismo que o infecta. Objetivo: Analisar o perfil bacteriológico do escarro de pacientes com bronquiectasia e avaliar seu efeito no transporte in vitro e na qualidade de vida dos pacientes. Métodos: Pacientes com bronquiectasia foram avaliados por questionários de qualidade de vida, cultura bacteriana e transporte in vitro do escarro. Resultados: Foram incluídos 19 pacientes com bronquiectasia, com média de idade de 38,6 ± 16 anos. O grupo de portadores de bactérias potencialmente patogênicas, com 10 pacientes (grupo I), foi comparado ao grupo de portadores de bactérias não patogênicas, com 9 pacientes (grupo II). O grupo I teve menor velocidade relativa e maior deslocamento por tosse que o grupo II (p < 0,05). Pelo questionário do Hospital Saint George, na doença respiratória, o grupo I apresentou pior qualidade de vida (domínio impacto) (p < 0,05). Pelo World Health Organization Quality of Life-abreviado, o grupo I também apresentou pior qualidade de vida (domínio físico). Em relação à cor do escarro, quanto mais escuro, menor a velocidade relativa de transporte ciliar (r =-0,646; p = 0,007) e maior o deslocamento por tosse (r = 0,756; p = 0,001). Conclusão: Pacientes com bronquiectasia portadores de bactérias potencialmente patogênicas no escarro apresentam pior qualidade de vida e pior transporte ciliar no palato de rã, porém têm melhor deslocamento do escarro na máquina de tosse quando comparados àqueles sem bactérias potencialmente patogênicas.

Adesividade e purulência de secreções respiratórias: implicações no transporte mucociliar em pacientes com bronquiectasias

“…Although the difference, in terms of the mucociliary transport velocity, between the purulent and mucoid samples evaluated in the present study (0.74 ± 0.22 vs. 0.82 ± 0.22) was slightly lower than was that found in the aforementioned study, (20) the difference between the two studies was not significant.…”

“…(5,6,13) Although previous studies have demonstrated a decrease in the ciliary transport of purulent secretions, (19,20) the results of the present study revealed that the impairment of the ciliary 551 respiratory system changes and impairment in individuals with the disease. However, as we gain a better understanding of the issue, the formulation of increasingly homogeneous groups becomes necessary, a task that is extremely difficult, since bronchiectasis is related to various underlying etiologies, age brackets, and degrees of contamination, among other confounding factors.…”

“…In individuals with bronchiectasis, the secreted expectoration can range from mucoid to purulent, a fact that is intimately related to the general status of patients, since these individuals are commonly infected with germs, such as pneumococci, Haemophilus influenzae, (8,9) Streptococcus pneumoniae, Moraxella catarrhalis, and P. aeruginosa. (8) Although the classification based on the macroscopic appearance of sputum is controversial among certain authors due to the lack of homogeneity of the color and the subjectivity of the choice, (16) other authors have stated that, in patients with bronchiectasis, (17,18) COPD, (19) or chronic bronchitis, (20) respiratory secretion purulence (an increase in color) correlates with the presence of inflammatory mediators and bacteria, (18,20) as well as with greater secretion volume, (17) worsening of the rheological profile, (10,21) lower ciliary beat frequency, and greater transport by cough (20) whereas a transparent to white (mucoid) appearance does not. Therefore, specific scales have been developed in order to make the between mucoid and purulent samples (9.04 ± 2.48 cm vs. 7.57 ± 2.91 cm; p < 0.05).…”

“…One group of authors (20) studied respiratory secretion samples collected from patients with bronchiectasis and found that the RTV on frog palate (p < 0.05) was lower in those of purulent appearance (0.80 ± 0.06) than in those of mucoid appearance (0.9 ± 0.1). Although the difference, in terms of the mucociliary transport velocity, between the purulent and mucoid samples evaluated in the present study (0.74 ± 0.22 vs. 0.82 ± 0.22) was slightly lower than was that found in the aforementioned study, (20) the difference between the two studies was not significant.…”

Qualidade de vida em voz na doença pulmonar crônica

“…Bronchiectasis is a CPD that causes change in ventilatory mechanics, such as loss of respiratory muscle strength, changes in lung volume and capacity, as a result of abnormal and irreversible dilatation of the bronchi, as a result of the destruction of the walls of the airways due to constant infections and inflammation 25,32 . According to some authors it is presented by different etiologies and may be suppurative and obstructive character 33 . COPD is characterized by a respiratory illness that causes chronic airflow obstruction.…”